Falsafa

The work of Greek philosophers, mainly Aristotle but also few of Plato, had been translated into Arabic very early after the Abbasid revolution in the 8^th century and continued down to the 10^th century. In fact, these great works of humanity were preserved by Muslims. Baghdad was the center of Science and Arts in the medieval world. Great Muslim philosophers of that time include al-Farabi (d. 950) in Baghdad, Ibn Sina (d. 1037) in Persia, Ibn Rushd (d. 1198) in Andalus.

 

Patricia Crone [1] writes in her fabulous “God’s Rule” that “[a] historian of mainstream Islam is apt to dismiss all philosophers as marginal (except in so far as they had other strings to their bows), for mainstream Islam was shaped by religious scholars, who were prone to rejecting philosophers and Ismailis alike as heretical.” On the other hand, the great theologian al-Ghazali (d. 1111) was also a philosopher. He rejected metaphysics as incompatible with Islam but insisted that nothing was wrong with the natural sciences, mathematics, logic, politics. Especially in Persia, Greek philosophical ideas were continuously absorbed into general Muslim culture. Nevertheless, in medieval times philosophers were often condemned as heretics or infidels. One famous example might be Omar Khayyam (d. 1122).

 

Wahhabism, which started in the 18^th century on the Arabian Peninsula, has effectively stopped that development and is now regarded the main reason for the present day stagnation and even retardation of Islam. The highly conservative movement has its main proponents in Saudi Arabia, Kuwait and the United Arab Emirates. There is not really a culture of philosophy in these countries any more. It was with some amazement, thus, when reading in the latest issue of Forschung und Lehre the report of a German female philosopher [2] who has been appointed the first full Professor in Philosophy at UAEU. Reading the article, I remembered my own enthusiasm in 2001 when having been called to help build up a new Faculty at Kuwait University. However, that was not in the Humanities but rather in Medicine. The new Philosophy Professor describes the procedures when having been appointed from a German point of view which sounds somewhat weird. In fact, it doesn’t fit my own experiences. I do not think that, for example, short-listing is actually done. Once you are invited for an interview, you will get the job offer. On the other hand, negotiations should take place, of course. I couldn’t find anything on intercultural competence in her article, which is by far the most important prerequisite when working and living in the Middle East. It is not only respect for the local culture but a kind of fond curiosity what is most helpful.

 

It will be interesting to follow-up Dr. Nicole’s, as she is called already by students and colleagues, further experiences and adventures in such an exotic place. And I am also more than curious to see whether the Arab culture will eventually listen to philosophers again.

 

 

Notes

[1] Crone P. God’s Rule. Government and Islam. Six Centuries of Medieval Islamic Political Rule. Columbia University Press, New York 2004.

[2] Karafyllis NC. Zwischen Wüste und Hightech. Forschung und Lehre 2008; 10(08): 692-694.

 

 

 

 

Embedded

Embedded journalism is anti-democratic. News reporters and hand-picked journalists have been attached to military units before the third war in the Gulf region (2003-) but the term ‘embedded’ has been used then for the first time and ever since. Embedded journalism is daily practice also in Afghanistan. But information warfare should be labeled as such when pictures of the battles are published which are mere propaganda.

Having lived many years in the Middle East, even during the initial phases of that war in nearby Iraq, my colleagues and I desperately depended on a number of brave reporters in Baghdad, Kabul, and Tehran, who were credibly not embedded, who authentically reported about the people and what was going on. One of them is BBC’s Jon Leyne in Tehran. His sympathy for the common Iranian is beyond any doubt. He obviously likes his job, and his intercultural competence opens doors for getting the information he inquires. His always interesting reportages are critical but he explores his subjects from different angles. He does not fuel preconceptions but explains and enlightens.

 

Another correspondent I want to name in this regard is Ulrich Tilgner. I had admired his sober and emphatic reports from Baghdad during the first US bombardments and afterwards. In the meantime he had moved, after the initial phases of the war, to Tehran. But now he had quitted his contract with Germany’s ZDF TV channel. Too much consideration of allies’ interests were the reason for that, one can read. It is a shame that this rather low quality German channel, in fact governed by public law, wants to focus more on ‘embedded journalism’ at a time when failure of the military adventures in the Middle East and Afghanistan is becoming obvious. When the German Bundestag has to renew the ISAF/OEF mandates for the German Armed Forces, the public needs to be fully informed about all the consequences, worst case scenarios, and how to get out of this war finally. Embedded journalism does not help in that situation very much.   

 

 

Pax Persica

When recently visiting Esfahan, I found in the old city a site which is known as Isaiah’s tomb. It is located in the small complex of the Emamzadeh Esma’il on the Kh. Hatef in the Yazdi quarter, the former Jewish quarter. The complex consists of buildings and a courtyard similar to the famous Darb-e Emam in the Dardasht quarter of Old Esfahan. The mausoleum and holy shrine of Ismail, the grandson of the second Imam Hasan is a later addition of the Safavid ruler Shah Abbas. The complex was expanded continuously till the 18^th century.

A very prominent Turkmen brick dome and a truncated Seljuq minaret belong to the undated Isaiah mosque. It is considered the oldest big mosque in Esfahan, and it is said that the mortal remains of the Prophet Isaiah have been found in its ruins [1]. Another legend tells that Jews, after having been freed from Babylonian Captivity by Cyrus the Great in 539 BCE, found a new refuge at the Zayandeh River in Central Persia where they settled and founded the city of Esfahan [2].

 

Trito-Isaiah

Biblical studies tell that the book of Isaiah has at least three authors. While Deutero-Isaiah mentions Cyrus II [3] who reigned 559-529 BCE, Trito-Isaiah, the third author (Isa 56-66), is typically assigned to the Persian period. Although not really confirmed by scientific research, one might assume an author who has lived around 500 BCE. Especially the central part of the chapter (Isa 60-62) seems to be the nucleus around which the rest of the collection conglomerated. The influence of the Achaemenid Empire on Jewish post-exile life in the marginal province of Yehud, their society and culture has found its way to Jewish scriptures, i.e., the books of the postexilic prophets.

 

The Apadana Reliefs

An amazing piece of speculation [4] about the impact of Achaemenid power as described, for example, in the static, almost unhistorical Apadana reliefs in Persepolis [5], or on the inscriptions and reliefs from Darius’ tomb in Naqsh-e Rostam on the vassal states in the Empire’s periphery [6] relates to Isaiah 60 [7]: A joyous cooperation in a ‘world under control’. It can be assumed that Jerusalem is addressed. But especially the solar imagery of Yaweh in Isa 60:1-3 and 19-20 strongly reminds of the portrait of Ahuramazda in the Apadana reliefs and elsewhere as a winged sun-disk.

 

Even more convincing might be the procession of tribute paying foreigners in Isa 60, in fact unforcefully offering gold and frankincense, even camels and sheep, which closely matches with details in reliefs from Persepolis. The naming the various nations in Isa 60 (Midian, Ephah, Sheba, Kedar, Nebaioth, Tarshish, Lebanon) strikingly parallels the list, for example, on Darius’ tomb in Naqsh-e Rostam and respective representations of different ethnicities in the Apadana reliefs. Tribute is paid to Yaweh here while the foreigners in Persepolis come to be presented to the king. But, as Strawn points out, the Persian King has to be considered in fact divine. Another analogy might be the garden imagery in Isa 13, 21 and the Persian paradeisoi.

 

Pax Persica

Thus, Trito-Isaiah seems to utilize very characteristic Persian text- and art-forms. In its abstract and even unhistorical theology, it might indeed reflect the fact that the well-established pax Persica of the Achaemenids has become a pax Jerusalem, as Strawn stresses.

 

Is it possible that Trito-Isaiah has visited or heard about Persepolis? While Strawn actually locates him in Jerusalem, there is this legend of a tomb in Esfahan. About 25 kilometers southeast to Esfahan further remarkable evidence for millennia-old Jewish life in Iran can be found in the small village of Linjan/Pir Bakran. The ancient Jewish cemetery is said to be at least 2000 years old. Pilgrims in particular visit the tomb of Sarah bat Asher, daughter of the son of the Patriarch Jacob. As burning candles proved, the small synagogue was still active when I visited the site in late 2007.

 

 

Notes

 

[1] According to Sylvia A. Matheson’s excellent archeological guide to Persia (1976), the first mosque dates back to the times of Imam Ali (d. 21^st Ramadan, 40 AH).

 

[2] It has to be mentioned here that the Jewish population in Iran has unfortunately decreased after the Islamic Revolution in 1979 to now less than 40’000.

 

[3] Isa 45:1 (Deutero-Isaiah) considers Cyrus II even as a messiah who had been sent by Yaweh.

 

[4] Strawn BA. “A World under Control”: Isaiah 60 and the Apadana reliefs from Persepolis. In Berquist JL (ed.) Approaching Yehud. New Approaches to the Study of the Persian Period. Brill, Leiden 2008

 

[5] Darius I, who ruled between 522 and 486 BCE, moved the Achaemenid capital from Pasargadae to Persepolis. The oldest buildings are dated around 515 BCE. His son Xerxes largely expanded the huge city and finished much of the work.  “It can be suggested that the ultimate goal of both the architecture and the decoration of Persepolis was to present to the world the concept of a Pax Persica – a harmonious, peaceful empire ruled by a king who contained within his person and his office the welfare of the empire.” … “ Characteristic of these reliefs is that they are entirely unhistorical: they tell no developing story, as did many reliefs of the Assyrians and the Egyptians. Instead they give a static picture of something that is already done, that already exists, that is accomplished (tribute brought, monsters slain, fire honored, dignitaries received). More important, the king is everywhere and is the focus, in one way or another, of almost all the reliefs. Yet this king is not an individual; there are no portraits of Darius, Xerxes, or Artaxerxes. Instead they project a dynastic image of the glory and concept of kingship, rather than a realistic depiction of a particular king. Thus the whole of even a complex composition such as the great reliefs on the stairways of the Apadana present a planned, spiritual, abstract, and almost cosmic composition of static totality.” (Young T Cuyler, Jr. Persepolis. Anchor Bible Dictionary 5: 236, cited in [4].)

 

[6] There Darius lists the names of the countries (Yehud is not mentioned) he had seized, by the favor of Ahuramazda. He points to the throne-carriers sculptured in Persepolis who, effortless and in the ‘Atlas pose’ represent an almost joyful support of the Emperor. 

 

[7] Isaiah 60

1 Arise, shine, for your light has come, and the glory of the Lord has shone upon you.

2 For behold, darkness shall cover the earth, and a gross darkness the kingdoms, and the Lord shall shine upon you, and His glory shall appear over you.

3 And nations shall go by your light and kings by the brilliance of your shine.

4 Lift up your eyes all around and see, they all have gathered, they have come to you; your sons shall come from afar, and your daughters shall be raised on [their] side.

5 Then you shall see and be radiant, and your heart shall be startled and become enlarged, for the abundance of the west shall be turned over to you, the wealth of the nations that will come to you.

6 A multitude of camels shall cover you, the young camels of Midian and Ephah, all of them shall come from Sheba; gold and frankincense they shall carry, and the praises of the Lord they shall report.

7 All the sheep of Kedar shall be gathered to you, the rams of Nebaioth shall serve you; they shall be offered up with acceptance upon My altar, and I will glorify My glorious house.

8 Who are these that fly like a cloud and like doves to their cotes?

9 For the isles will hope for Me, and the ships of Tarshish [as] in the beginning, to bring your sons from afar, their silver and their gold with them, in the name of the Lord your God and for the Holy One of Israel, for He has glorified you.

10 And foreigners shall build your walls, and their kings shall serve you, for in My wrath I struck you, and in My grace have I had mercy on you.

11 And they shall open your gates always; day and night they shall not be closed, to bring to you the wealth of the nations and their kings in procession.

12 For the nation and the kingdom that shall not serve you shall perish, and the nations shall be destroyed.

13 The glory of the Lebanon shall come to you, box trees, firs, and cypresses together, to glorify the place of My sanctuary, and the place of My feet I will honor.

14 And the children of your oppressors shall go to you bent over, and those who despised you shall prostrate themselves at the soles of your feet, and they shall call you ‘the city of the Lord, Zion of the Holy One of Israel.’

15 Instead of your being forsaken and hated without a passerby, I will make you an everlasting pride, the joy of every generation.

16 And you shall suck the milk of nations and the breast of kings you shall suck, and you shall know that I am the Lord, your Savior, and your Redeemer, the Mighty One of Jacob.

17 Instead of the copper I will bring gold, and instead of the iron I will bring silver, and instead of the wood, copper, and instead of the stones, iron, and I will make your officers peace and your rulers righteousness.

18 Violence shall no longer be heard in your land, neither robbery nor destruction within your borders, and you shall call salvation your walls and your gates praise.

19 You shall no longer have the sun for light by day, and for brightness, the moon shall not give you light, but the Lord shall be to you for an everlasting light, and your God for your glory.

20 Your sun shall no longer set, neither shall your moon be gathered in, for the Lord shall be to you for an everlasting light, and the days of your mourning shall be completed.

21 And your people, all of them righteous, shall inherit the land forever, a scion of My planting, the work of My hands in which I will glory.

22 The smallest shall become a thousand and the least a mighty nation; I am the Lord, in its time I will hasten it.

 

 

Palestine Wiped Off the Map

Medical Information Transfer into Practice in the 21st Century: A Revolution

 

 

Advance! Advance! We advance. We advance. Can we advance? Can we advance? Can we? Can we? Henry Cow 1980 [1]

 

When having recently been asked to write an op-ed, I was wondering whether the above could be a good expression for the last, say, three decades of Periodontology which I have witnessed as a professional, a periodontist, university teacher, and researcher [2]. The formulation of a specific plaque hypothesis, the discovery that dental plaque is organized as a biofilm, the possibility of guided and other kinds of tissue regeneration, building up a scientific foundation of, before that very much ailing, implant dentistry, a new paradigm of the pathogenesis of periodontal diseases; and finally the emergence of periodontal medicine have kept us busy in a way, which nobody would have expected who has done his or her undergraduate studies in the 1970s. And then, basic and clinical sciences lately converged in Periodontology leading to the overall impression of scientific progress accelerating at an exponential pace [3].

 

The knowledge transfer from the teaching and research institutions to the private practitioner was, in all these years, mainly facilitated by commercial companies, which were eager to constantly develop new, sometimes groundbreaking, materials and technologies. Especially in the 1990s, progress was more or less driven by commercial competition, and some University teachers quickly became scientific consultants in small start-ups or bigger oral health care companies.

 

But while the dental profession greatly benefited from technological progress in these years, the question remained: is all doable also in the interest of the patient? 

 

Well, in my opinion the real revolution started with the implementation of search engines and, in particular, general availability of biomedical databases in the late 1990s. Electronic access to full text articles and journals became available in about 1998. Backfile issues were provided very recently by more and more biomedical journals. That quickly enables us to retrieve the exploding amount of information in a reasonable way and, at the same time, focus on the relevant clinical questions while filtering the evidence.

 

Periodontology may in fact be a forerunner in the Dental sciences. In several workshops which had mainly been organized by the American Academy of Periodontology, the European Federation of Periodontology and the European Association of Osseointegration, the principles of evidence based medicine [4] had strictly been applied in order to identify fields where evidence was lacking so far. The results had been published in numerous systematic reviews, which represent the highest level of available evidence. Moreover, the quality of reported clinical trials has been improved over the last few years, and more and more dental journals are now applying established standards for reporting clinical evidence such as Consolidated Standards of Reported Trials (CONSORT) in order to facilitate clarity and transparency [5]. As a notable innovation, the new edition of a classical textbook of Periodontology [6] now starts with an introduction to evidence based medicine, a chapter on assessing the evidence and a third one on evidence based decision making.

 

Altogether, these developments will have tremendous consequences for us, the teachers and former ‘opinion leaders’, as well. The latter attribute will inevitably vanish. Personal opinions will no longer dominate our teaching. Evidence based medicine can now be introduced to new generations of medical and dental students so that they can find the relevant information mainly by themselves. The teacher develops into a facilitator. And students identify primary knowledge instead of being taught subjective preferences. Application of the principles of evidence based medicine will automatically lead to evidence based decision making and evidence based practice. As DeHart Hurd [7] has pointed it out, the wider knowledge about and skills for providing evidence based medicine will help the health professionals meet the desired educational outcomes in being able to distinguish, for example, theory from dogma, data from myth, evidence from propaganda (advertisement), fact from fiction, knowledge from opinion. Tomorrow’s doctors will be, and have to be, able to gain, assess, apply, and integrate new knowledge in real time, and they must be willing to adapt to changing circumstances throughout their professional life.

 

In the meantime, basic knowledge and skills for evidence based practice have been demanded and set out for medical students [8]. The most difficult step might in fact be to get students, and even more colleagues, to recognize and admit uncertainties. Practical orientation demands that teaching and assessment of evidence based practice in real time needs to be done in minutes rather than hours or days.

 

Dental curricula so far hardly provide the necessary skills and competencies for retrieving the relevant evidence so that future dental practitioners (not scientists) will be able to make evidence based decisions for the benefit and in the interest of their future patients (not necessarily those of the dentist). Evidence based practice requires a health care infrastructure committed to best practice, and being able to provide full and rapid access to electronic databases at the point of care delivery.

 

At least at our University Dental School, one of the most modern institutions of its kind in the world, this might no longer be science fiction. Each dental chair in the student clinic is now connected to the internet. So, focused clinical questions can easily be addressed in real time, i.e., while the patient is still sitting in the chair. If already present, abstract, main message and conclusion of a systematic review may immediately be discussed with the patient and preliminary recommendations given while students are advised to critically read the paper by the patient’s next appointment.

 

The next few years will certainly see a revolution in dental education and profound changes in attitudes with regard to new developments in Dentistry. Besides being taught the various technical procedures and useful materials, students will now be informed about the results of systematic reviews or, if missing, randomized controlled clinical trials. While this will establish the necessary confidence about the firm foundation of our daily decision making, skills and competencies in critically assessing the current evidence will prevent an entire new generation of dentists from blindly following unjustified promises of commercial companies.

 

Notes

 

[1] Entire works of Henry Cow. Bonus track on: Frith F. Speechless, RecRec 1992.

[2] It might be considered somewhat offbeat but I thought the Entire Works of Henry Cow, condensed in a one minute track, would probably fit that purpose well. The avant-garde, musique concrete cacophony representing exploding information and the exalted voice of singer Dagmar Krause expressing hopes and fears might in fact serve as the ideal introduction to my topic.

[3] Page RC. Milestones in periodontal research and the remaining critical issues. J Periodont Res 1999; 34: 331-339.

[4] Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ 1996; 312: 71-72.

[5] Needleman I, Moher D, Altman DG, Schulz KF, Moles DR, Worthington H. Improving the clarity and transparency of reporting health research: a shared obligation and responsibility. J Dent Res 2008; 87: 894-895.

[6] Newman MG, Takei HH, Klokkevold PR, Carranza FA. Carranza’s Clinical Periodontology. 10th ed. Saunders Elsevier, St. Louis 2006.

[7] DeHart Hurd P. Scientific literacy: new minds for a changing world. Sci Edu 1998; 82: 407-416.

[8] Dawes M, Summerskill W, Glasziou P, Cartabellotta A, Martin J, Hopayian K, Porzsolt F, Burls A, Osborne J. Sicily statement on evidence-based practice. BMC Med Educ 2005; 5: 1.